Provider Demographics
NPI:1508614751
Name:BROWN, MARY ANGELEE LIMOCON (RDN)
Entity type:Individual
Prefix:MRS
First Name:MARY ANGELEE
Middle Name:LIMOCON
Last Name:BROWN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 374
Mailing Address - Street 2:
Mailing Address - City:PORT HADLOCK
Mailing Address - State:WA
Mailing Address - Zip Code:98339-0374
Mailing Address - Country:US
Mailing Address - Phone:360-215-0735
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:90 KEM ST
Practice Address - Street 2:
Practice Address - City:PORT HADLOCK
Practice Address - State:WA
Practice Address - Zip Code:98339-9534
Practice Address - Country:US
Practice Address - Phone:360-215-0735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI61524678133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered